Since the publication of the 2004 guidelines, additional data
regarding steroid use have emerged. Significantly different
results were found in another multicenter trial from Europe
,CORTICUS) [27]. This study examined 28 day mortality)
length of stay, and complications in septic patients who wer
unresponsive to fluid resuscitation requiring vasopressors. The
majority of patients were surgical (65%) and had septic shock
with documented infection; 47% were non-responders to an
ACTH stimulation test. Patients in the steroid arm received 50
mg of intravenous hydrocortisone every 6 hours for 5 days that
was then tapered. Fludrocortisone was not administered in
,%this study. There was no difference in 28 day mortality regardless
of response to an ACTH stimulation test (39.2% vs. 36.2
,%P = 0.69 in ACTH-unresponsive patients and 28.8% vs. 28.7
P = 1.00 in ACTH-responsive patients). While earlier reversal
of shock was identified in the hydrocortisone group, infectious
.complicatio